This review summarizes and updates data presented at recent annual Southern Medical Association conferences on postmenopausal osteoporosis. As part of any osteoporosis treatment program, it is important to maintain adequate calcium and 25-hydroxyvitamin D levels either through diet or supplementation. Among the available pharmacologic therapies, the bisphosphonates alendronate and risedronate have demonstrated the most robust fracture risk reductions- approximately 40 to 50% reduction in vertebral fracture risk, 30 to 40% in nonvertebral fracture risk, and 40 to 60% in hip fracture risk. Ibandronate, a new bisphosphonate, has demonstrated efficacy in reducing vertebral fracture risk. Salmon calcitonin nasal spray and raloxifene demonstrated significant reductions in vertebral fracture risk in pivotal studies. Teriparatide significantly reduced vertebral and nonvertebral fracture risk. Drugs on the horizon include strontium ranelate, which has been shown to reduce vertebral and nonvertebral fracture risk, and zoledronic acid, an injectable bisphosphonate that increased bone density with once-yearly administration.

Type 2 diabetes (T2D) is increasing in the United States, currently affecting 11.3% of the nation. The Developmental Origins of Health and Disease Hypothesis suggests that environmental stresses in utero and in early stages of life, such as preterm birth (age), can lead to development of adulthood diseases, including T2D. However, research on the association between preterm birth and T2D is sparse and predominantly based on European ancestry populations. We examined this association in postmenopausal women (N = 85,356) from the Women’s Health Initiative, a nationwide prospective cohort. Logistic regression models were used to examine the association between self-reported preterm birth and T2D status, adjusting for demographic and lifestyle covariates. Preterm birth was significantly and positively associated with odds of T2D at baseline (unadjusted: OR=1.51, 95% CI 1.24, 1.83; P

Prevention är en viktig men otillräckligt utvecklad del av sjuksköterskans omvårdnadsarbete vad gäller kvinnor i riskzonen för att utveckla osteoporos. Syftet med denna litteraturstudie är därför att belysa vilka faktorer som är av betydelse i det preventiva arbetet gällande osteoporos hos kvinnor i postmenopaus. Metoden är en litteraturstudie, som genomfördes med inspiration av Goodmans modell. Till studien användes 11 vetenskapliga artiklar som granskades enligt protokoll ur Willman och Stoltz (2002). Resultatet indelades i fem teman; Kostens betydelse, Solljus som källa till vitamin D, Fysisk aktivitet, Rökningens inverkan på benmassan samt sjuksköterskans preventiva patientundervisning. Det är viktigt att kosten innehåller bland annat kalcium, protein och C-vitamin. Det är viktigt att exponeras för solljus för att kunna tillgodose sig vitamin D. Fysisk aktivitet i olika former rekommenderas och rökningens negativa inverkan på benmassan. Sjuksköterskan har en betydande roll i undervisning av patienter i det förebyggande arbetet. Slutsatsen är att det är effektivt att arbeta preventivt med postmenopausala kvinnor som har osteoporos. / Prevention is an important part of the work to reduce the development of osteoporosis, were unfortunately enough effort is not used on women. The purpose of this literature review is therefore illuminate which factors could be of importance in the preventive work when it comes to osteoporosis in postmenopausal women. The method is a literature review, carried out with inspiration in Goodman’s model. For the study, eleven scientific articles were used that were revised according to a protocol in Willman & Stoltz (2002). The result were divided into five themes; the importance of diet, sunlight as a source of vitamin D, Physical activity, The influence of smoking on bone mass and the nurse’s preventive patient education. The result showed that it is important that the diet contains for example calcium, protein and vitamin C. Exposure to sunlight is also important to provide for vitamin D. Physical activity of various types is recommended and to quit smoking stop the negative effect on bone mass. The nurse has an important role in educating patients in the preventive work. The conclusion is that it is effective to work preventive with postmenopausal women with osteoporosis.

The D-spacing that is characteristic of collagen and its structural arrangement was previously thought to be a constant value. Much research is revealing that it is actually a distribution of values in biological tissues. Recent ovine experimentation has also shown that the D-spacing distribution is significantly altered following estrogen depletion. While ewes contain some major biological differences between their human counterparts, they are an economical and robust large animal model for postmenopausal osteoporosis. So, the exploration of the possible implications that D-spacing has on the mechanical properties of the whole bone utilizing animal models and computational methods is warranted. Six Warhill ewes were used in this experiment and were either ovariectomized or underwent a sham surgery. The animals were sacrificed after 3 years and the radius and ulna bone were harvested for further analysis. Rectangular beams of compact bone tissue were machined from six different sectors in the whole bone and dynamic mechanical analysis tests were performed on the 24 specimens. The viscoelastic property, tangent delta, was measured from each test at varying frequencies. A composite arrangement of collagen and hydroxyapatite were then computationally modeled utilizing finite element analysis to observe the effects of altered D-spacing on the mechanical properties. Jager and Fratzl’s staggered array model allowed the inclusion of a D-spacing configuration as well as the simplified 2 dimensional plane strain analysis. Hydroxyapatite was modeled as a perfectly elastic material, while the hydrated collagen component was linear viscoelastic through the use of the standard linear solid model. The main finding of the work is that D-spacing only significantly altered the tangent delta of the computational model when the mineral volume fraction changed. Since the composite model analyzed the structural arrangement of compact bone at such a small scale, the change in mineral volume fraction could only be realistically attributed to intrafibrillar mineral. The results of this preliminary analysis are promising and warrant the continued investigation of D-spacing and mineral content and their significance in the osteoporotic condition.

The purpose of this study is to characterize the compact bone remodeling of the ovariectomized ewe and its effectiveness as an animal model for studies of postmenopausal osteoporosis. The use of animal models is a beneficial way to evaluate the effectiveness of medical devices and therapeutic agents for treating diseases. The ovine model is an attractive option because of its large size and similar bone remodeling to humans. However, this species, like most animals, does not undergo a natural menopause, making an ovariectomy necessary for studies of estrogen depletion. The OVX (ovariectomized) sheep has been widely accepted as a model for loss of BMD. However, even with its advantages seasonality has been shown to have an effect on the bone remodeling in the ovine model. Thus, this study focused on characterizing the seasonal and anatomical variation in the compact bone remodeling in the ovine model. In doing so, 28 skeletally mature Columbia-Rambouillet cross ewes underwent an ovariectomy. The animals were divided into groups of 7 based on each season: autumn, winter, spring, and summer. During its specified season each group of 7 underwent ovariectomy and then was sacrificed 12 months post-surgery. The radii and ulnae were harvested and then divided into 6 anatomical locations: craniolateral, cranial, craniomedial, craniolateral, caudal, and caudomedial. This allowed for analysis through the fabrication of microradiographs. Histomorphometric analysis involved measurements to quantify the bone volume to tissue volume ratio, the percent of tissue and material remodeling, the mean secondary osteonal radius, and number of tissue and material cement line interfaces. Densitometry analysis was then performed to determine the density of each sector relative to an aluminum step wedge, serving as the key. Using a 2-way repeated measures ANOVA statistical analysis was performed to evaluate for seasonal and anatomical differences as well as a possible interaction between season and anatomical region. The OVX data showed significant seasonal and anatomical differences as well as seasonality within anatomical section in the remodeling parameters. When this data was combined with earlier data from a control, sham-cohort from the same experiment a 3-way ANOVA was also performed to evaluate the effects of season, anatomical sector, and treatment on the remodeling parameters. Again, there was significant seasonal, anatomical, and treatment differences, as well as interactions of all three. The results of this study showed that varying levels of remodeling occurs in the adult OVX ovine model and differences between the control and OVX model can be attributed to seasonal and anatomical variations. Thus, it will be an important consideration when developing new test protocols for research incorporating the sheep model for studying osteoporosis.

Recent studies have shown that postmenopausal follicle stimulating hormone (FSH) levels may be predictive of future cardiovascular disease risk. However, little is known about postmenopausal FSH levels, including the level of variation between women and factors associated with this variation. We assessed the relationship of multiple reproductive factors with FSH levels among 588 postmenopausal women in the Kuopio Ischemic Heart Disease Risk Factor Study. Participants were aged 53 to 73 years and not using hormone therapy at baseline (1998-2001). Reproductive factors were assessed at baseline, along with FSH levels. After adjustment for sex steroids, adiposity measures, plasma lipids, blood pressure, and behavioral factors, we observed that women with 3 or more births and an age at first birth of 25 or later had mean FSH levels that were significantly 7.6 IU/L lower than those of women with a 1 to 2 births and an age at first birth of 24 or less. Number of miscarriages was inversely correlated with FSH levels. Women reporting a 7 or more years of OC use and 4-6 or 7 or more years of HT use each had significantly higher mean FSH levels than women who had never used OCs or HT. In summary, multiple reproductive factors were associated with postmenopausal FSH levels, independent of estradiol, adiposity, and other factors. These findings warrant replication and further exploration of potential underlying mechanism.

A growing body of evidence has demonstrated that soy isoflavone consumption may protect against the development of various chronic diseases. This protection could be linked to isoflavone-induced alterations in immune function. However, recent in vitro and animal studies suggest that soy isoflavones may either enhance or suppress immunocompetence, depending upon the isoflavone concentration, target tissue, and a number of other factors. To date, no study has investigated the effect of dietary soy isoflavone supplementation on immune parameters in humans. Therefore, the purpose of this double-blind, placebo-controlled, 4 wk intervention trial was to investigate whether supplementation with soy isoflavones alters indices of immune function in postmenopausal women. Twenty healthy women (50-69 yr), who were not on hormone replacement therapy, were randomly divided into 2 treatment groups. The supplemented group (n=10) consumed soy isoflavone tablets (100 mg/d) for 4 wk, while the control group (n=10) received placebo tablets. Fasting blood samples were drawn at baseline and on d 28 to assess specific immune parameters. In addition, plasma concentrations of genistein and daidzein were quantified at baseline and at the end of the intervention period. Despite high individual variability among subjects, there was a significant increase (p<0.005) in plasma isoflavone concentration in the supplemented group. However, all assessed immune parameters remained unchanged after supplementation and did not differ between the 2 treatment groups. In conclusion, this study suggests that short-term soy isoflavone supplementation at physiologically attainable concentrations does not alter the aforementioned immune parameters in healthy postmenopausal women. Due to the conflicting data concerning the effect of dietary soy isoflavones on immune function, further research in this area is warranted. / Master of Science

A growing body of evidence has demonstrated that soy isoflavone consumption may protect against the development of various chronic diseases. This defense could be linked to isoflavone-induced alterations in immune function. However, to date, no study has examined the effect of soy isoflavone supplementation on human immunity in vivo. Establishing whether isoflavones affect immunity in aging adults is particularly relevant since compromised immune function has been observed in this population. Therefore, the purpose of this double-blind, placebo-controlled, 4-wk intervention trial was to investigate whether supplementation with soy isoflavones influenced the distribution and/or function of specific lymphocytes in postmenopausal women. Healthy postmenopausal women (50-69 y), who were not using hormone replacement therapy, were randomly divided into 2 treatment groups. The experimental group (n=9) consumed two-50 mg soy isoflavone tablets/d for 4 wk, while the control group (n=9) received placebo tablets. Fasting blood samples were drawn at baseline and on d 28 to assess distribution of T-helper cells (CD3+CD4+), T-cytotoxic cells (CD3+CD8+), total T lymphocytes (CD3+), B lymphocytes (CD19+) and natural killer (NK) cells (CD16+CD56+) via flow cytometry. Cytotoxicity of NK cells was quantified based on lactate dehydrogenase release of lysed K562 cancer cells following co-culture with NK cells from subjects. Analysis of plasma isoflavone concentrations by HPLC demonstrated a significant increase (p<0.005) in plasma genistein concentration in the experimental group after 4 wk of supplementation. However, there was no alteration in lymphocyte distribution or NK cell activity in response to isoflavone supplementation, suggesting that short-term soy isoflavone supplementation does not alter these parameters of immunity in healthy postmenopausal women. / Master of Science

No description available.

<p>Uvod: Osteoporoza je sistemsko oboljenje skeleta koje se karakteri&scaron;e smanjenjem mase kosti i promenama u ko&scaron;tanoj strukturi, &scaron;to sve ima za posledicu povećanu sklonost ko&scaron;tanog tkiva ka prelomima. Prema preporuci Svetske zdravstvene organizacije, dijagnoza osteoporoze postavlja se ukoliko je T-score -2,5 SD i ispod te vrednosti, a normalan nalaz ako je vrednost T-score -1,0 SD i iznad te vrednosti. Danas se smatra da je zlatni standard u dijagnostici osteoporoze primena dvostruke X apsorpcione denzitometrije lumbalne kičme i kuka putem koje se dobiju vrednosti ko&scaron;tane mase Bone mineral density i T-score. Međutim, poznato je da postoje faktori rizika koji utiču na redukciju mase kosti na taj način &scaron;to smanjuju maksimum mase kosti koji se stiče do 35. godine života i / ili ubrzavaju inače normalan proces postepenog i blagog smanjenja mase kosti koji počinje posle 35. godine života i na taj način povećavaju rizik za frakture. Takođe, poznato je da neki od faktora rizika i njihova udruženost može dovesti do povećanog rizika za frakture i nezavisno od ko&scaron;tane mase i T-score. Ciljevi istraživanja : 1. Utvrditi ko&scaron;tanu masu u postmenopauznih žena primenom dvostruke X apsorpcione denzitometrije. 2. Analizirati distribuciju faktora rizika u pacijentkinja sa T-score ispod -2.5 SD u poređenju sa pacijentkinjama sa T-score iznad -1.0 SD. 3. Utvrditi odnos između statističkog prostora koji čine pojedinačni i udruženi faktori rizika (sa karakteristikama svakih od njih) i mase kosti određene denzitometrijski. Materijal i metode rada: Istraživanje je koncipirano delom kao prospektivna, a delom kao retrospektivna studija koja je sprovedena kod pacijentkinja u postmenopauznom periodu života, životne dobi od 50 do 80 godina. Nakon urađene dvostruke X apsorpcione denzitometrije lumbalne kičme i kuka ispitivane pacijentkinje su same popunjavale upitnik uz pomoć medicinske sestre ili lekara. Nakon dobijenih podataka pacijentkinje su podeljene u dve grupe: sa osteoporozom i bez osteoporoze. U grupi sa osteoporozom je bilo 270 pacijentkinja, a u grupi bez osteoporoze 250 pacijentkinja. Potom je sprovedena statistička obrada podataka. Nakon sveobuhvatne analize dobijenih rezultata istraživanja izvedeni su sledeći zaključci: 1.Ustanovljeno je da 60% postmenopauznih žena prosečne životne dobi od 67.0 &plusmn; 7.0 godina ima osteoporozu odnosno vrednost T-score &le; -2.5 SD. 2. Postoji statistička značajna povezanost između ko&scaron;tane mase i sledećih faktora rizika: pozitivna porodična anamneza na osteoporozu i frakture, telesna težina, telesna visina, ranije frakture, česti padovi i smanjenje u visini vi&scaron;e od 3 cm. 3. Analizom faktora rizika se dobijaju karakteristike osoba sa osteoporozom: pozitivna porodična anamneza na osteoporozu i frakture, manja telesna težina i telesna visina, smanjenje u visini vi&scaron;e od 3 cm, česti padovi i ranije frakture. 4. Hipertireoidizam i hiperparatireoidizam, reumatoidni artritis, primena kortikosteroidne terapije su faktori rizika koji su vi&scaron;e zastupljeni kod ispitivanih pacijentkinja sa osteoporozom. 5. Pu&scaron;enje, rana menopauza, alergija na mleko bez adekvatne supstitucije sa kalcijumom i nedovoljan boravak na suncu bez adekvatne supstitucije sa vitaminom D su faktori rizika koji su vi&scaron;e zastupljeni kod ispitivanih pacijentkinja sa osteoporozom. 6. Najveći doprinos celini daje pozitivna porodična anamneza na osteoporozu i frakture (20.99%), zatim slede telesna težina, telesna visina, Index telesne mase (19.03%), ranije frakture, česti padovi, smanjenje u visini vi&scaron;e od 3 cm (18.41%), pu&scaron;enje i nedovoljna fizička aktivnost (12.75%), alergija na mleko i nedovoljan boravak na suncu (12.14%), rana menopauza (8.72%), hipertireoidizam, hiperparatireoidizam, reumatoidni artritis (7.93%). 7. Analizom tri grupe obeležja koja daju najveći doprinos celini ustanovljeno je da pozitivna porodična anamneza na frakture (37.7%) i telesna težina (31.3%) predstavljaju major faktore rizika za osteoporozu. 8. Matematičkom obradom dolazi se do formule pomoću koje bi sa verovatnoćom od 64.0 % mogla predvideti osteoporoza, a sa verovatnoćom 73.2 % odsustvo osteoporoze, čime se između ostalog u na&scaron;em istraživanju donekle relativizuje neophodnost određivanja ko&scaron;tane mase u proceni rizika za prelome i u proceni potrebe za uvođenje antiosteoporotične terapije. Formula je +.214 O +.562 F +.202 R +.223 P +.335 S +.493 T +.057 V +.020 9. Potrebno je testirati dobijenu formulu na ispitivanim pacijentkinjama i nastaviti istraživanje na većem uzorku na faktore rizika koji nisu pokazali statističku značajnost.</p> / <p>Introduction: Osteoporosis is a systematic disease of skeleton characterized by the reduction of bone mass and changes in bone structure which result in the increased aptitude of bone tissue to fractures. According to the suggestion of the World Health Organization, the diagnosis for osteoporosis is set if the T-score is -2.5 SD and below it and the normal report if the value of T-score is -1.0 SD and above it. Nowadays, it is considered that the golden standard in osteoporosis diagnostic is the use of double X absorption densitometry of lumbal spine and hipe which provides the values of bone mass Bone mineral density as well as T-score. However, it has been known that there are risk factors whish influence the reduction of bone mass by reducing maximum bone mass gained by the age of 35 and/or by quckening, the normal process of gradual and mild reduction of bone mass starting after 35 and in that way increase the risk toward fractures. It mas also been known that some of the risk factors and their correlation may cause the increasement of the risk factor toward fractures not having the connection with the bone mass and T-score. Researchment aims: 1. Determine bone mass in postmenopausal women using double X absorption densitometry. 2. Analyse distribution of risk factors in patients whith the T-score below -2.5 SD comparing to the patients with T-score above -1.0SD. 3. Determine the relation between statistical space made by individual and associated risk factors (with the characteristics of each of them) and the bone mass specified by densitometry. Material and methods of working: Researchment is outlined partly as prospective and partly as retrospective study which was carried out in patients in postmenopausal life period, aged 50-80. After applying double X absorption densitometry of lumbal spine and hip the examined patients did the questionnaire by themselves whith the help of nurses and doctors. After obtaining the data, patients were divided into two groups: with and without osteoporosis. There were 270 patients in the group with osteoporosis and 250 of them without it. Thereafter, the statistic data processing was carried out. After the overall analysis of obtained results of researchment, following conclusions were conducted: 1. It has been determined that 60 % of postmenopausal women of average age 67.0&plusmn;7.0 have osteoporosis, in other words, their T-score is &le; -2.5 SD. 2. There is statistically important relationship between the bone mass and following risk factors: positive family anamnesis to osteoporosis and fractures, body weight, height, previos fractures, frequent falls and reduction of height for more than 3 cm. 3. Analysing the risk factors, characteristics of persons with osteoporosis have been obtained: positive family anamnesis to osteoporosis and fractures, smaller body weight and height, the reduction in height for more than 3 cm, frequent falls and previous fractures. 4. Hyperthyroidism and hyperparathyroidism, rheumatoid arthritis and the usage of corticosteroid therapy are the risk factors more incident in the examined patients with osteoporosis. 5. Smoking, early menopause, allergy to milk with no adequate substitution of calcium and insufficient exposition to sun rays with no adequate substitution of vitamine D are the risk factors more incident in patients with osteoporosis. 6. The largest contribution to the total makes positive family anamnesis to osteoporosis and fractures (20.99%), followed by body weight, height, Body mass index (19.03%), previos fractures, frequent falls and reduction in height for more than 3 cm (18.41%), smoking and insufficient physical activity (12.75%), allergy to milk and insufficient exposition to the sun (12.14%), early menopause (8.72%), hyperthyroidism and hyperparathyroidism, rheumatoid arthritis (7.93%). 7. By the analysis of all three goups of features giving the largest cintribution to the total, it has been determined that positive family anamnesis to fractures (37.7%), and body weight (31.3%), present the major risk factors for osteoporosis. 8. By mathematical processing we obtain the formula which can with the probability of 64.0% predict osteoporosis, and with the probability of 73.2% the absence of osteoporosis, which can, among other things in our research to some extent, require relative necessity for introduction of antiosteoporotic therapy. The formula is +.214 O +.562 F +.202 R +.223 P +.335 S +.493 T +.057 V +.020. 9. It is necessary to test the formula obtained in examined patients and continue the reseachment, on larger sample, of risk factors which have not shown statistic importance.</p>